Intergenerational transmission of health disparities among Turkish-origin residents in Germany: role of maternal stress and stress biology during pregnancy.

解决健康差距问题的重要性已得到公认。土耳其裔移民和德国本土人之间的健康差距在几代人之间长期存在，从生命的最初阶段就开始显现，基于这一考虑，我们认为，这些健康差距的根源部分可追溯到母亲的社会不利地位对其胎儿在宫内生命的关键时期发育的影响。我们提出了一个假设，即在胎儿生命期间，环境和时间不适当的社会障碍相关应激生物学暴露水平（母体-胎盘-胎儿（MPF）内分泌和免疫/炎症状态）可能会以影响随后健康和疾病风险相关结果的方式编程细胞，组织和器官系统的结构和功能完整性。作为解决这一假设的重要的第一步，我们试图阐明产妇的迁移状态和社会经济地位（社会劣势的主要代理措施）的压力相关的MPF生物过程在整个妊娠期的影响。我们建议在一组土耳其裔和德国裔妊娠妇女中进行一项前瞻性纵向研究。我们的建议的一个独特优势是，目前正在招募一个由1500名不同背景的母亲-儿童二人组组成的队列，这些母亲-儿童二人组的移民身份和SES（BaBi研究，BMBF资助01 ER 1202，Jacob Spallek，PI）。该队列将在妊娠过程中和出生后就个体和背景因素以及0-4岁时的儿童健康结局进行表征。目前的提案要求提供资金，在N=300名妇女（N=150名土耳其背景的移民和N=150名德国本土妇女）的一个亚组中，在妊娠中期和妊娠晚期的两个时间点增加内分泌（CRH，皮质醇）和免疫（CRP，IL-6）应激生物学的测量。我们已经组建了一支由具有互补专业知识的知名调查人员组成的跨学科团队。我们的研究将产生有关德国土耳其裔居民健康的新信息，并阐明脆弱性代际循环的原因和机制。

The importance of addressing the issue of health disparities is well established. Based on the consideration that many of the population health disparities between immigrants of Turkish origin and native Germans that are perpetuated across generations are manifest from the earliest stages of the lifespan onwards, we posit that the origins of these health disparities may trace back, in part, to the effects of maternal social disadvantage on her child's development during the critical period of intrauterine life. We advance the hypothesis that context- and time-inappropriate levels of social disadvantage-related stress biology exposures (maternal-placental-fetal (MPF) endocrine and immune/ inflammatory state) during fetal life may program the structural and functional integrity of cells, tissues and organ systems in a manner that impacts subsequent health and disease risk-related outcomes. As an essential first step towards addressing this hypothesis, we seek to elucidate the effects of maternal migration status and socioeconomic status (the principal proxy measures of social disadvantage) on stress-related MPF biological processes across gestation. We propose to conduct a prospective, longitudinal study in a cohort of Turkish-origin and German-origin pregnant women recruited during early gestation. A unique strength of our proposal is the availability of a cohort of 1500 mother-child dyads of diverse background in terms of their migration status and SES (BaBi-study, BMBF grant 01ER1202, Jacob Spallek, PI) that is currently being recruited. This cohort will be characterized over the course of pregnancy and postnatally with respect to individual and contextual factors and child health outcomes at 0-4 years. The current proposal requests funds to add measures during pregnancy of endocrine (CRH, cortisol) and immune (CRP, IL-6) stress biology at two time points in the second and third trimesters of gestation) in a subgroup of N=300 women (N=150 immigrants of Turkish background, and N=150 native German women). We have assembled an interdisciplinary team of established investigators with complementary expertise. Our study will generate new information about the health of Turkish-origin residents in Germany and shed light on the causes and mechanisms of intergenerational cycles of vulnerability.